The aim of this assignment is to discuss the patient’s journey, describe how a professional approach to Codes of Conduct, confidentiality, patient advocacy is important and to also discuss where evidence based practice is important in the care of the surgical patient. In order to show where these are important in the care of a surgical patient a fictitious case study will be used. The case study will be about Tom, a 65 year old man who has suffered for more than a year with urinary problems and will therefore be undergoing a surgical procedure called Trans Urethral Resection of the Prostate. We will follow Tom on his journey throughout his stay in the Theatre department.
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When the theatre is ready to do Tom’s procedure they ring down to the day surgery ward to request that Tom can come up to theatre. Once Tom has arrived into the forward waiting reception area the operating department practitioner in the anaesthetic role greets Tom and does some checks to ensure he is the correct patient having the correct operation. Checks would include, Tom confirming his full name and date of birth, and the operating department practitioner checking this information along with Tom’s hospital number against the paperwork in Tom’s patient file and also the information tag on Tom’s wrist (Kumar ????). A discreet and professional manner is a must from the operating department practitioner at all times as any information discussed with Tom at any stage of his theatre visit is very confidential as explained in detail further on in the assignment (HPC 2011). All these checks are a major part of professional codes of conduct and regulations of the World Health Organisation (WHO).
The NMC Code of Professional Conduct: standards for conduct, performance and ethics (NMC 2004) states “to practise competently, you must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision, you must acknowledge the limits of your professional competence and only undertake the limits of your professional competence and only undertake practice and accept responsibilities for those activities in which you are competent”.
Evidence based practice has shown that with these checks in place mistakes are less likely to happen. In a press release in November 2010 the chairman of the NPSA states “the routine use of a checklist reduces death and harm amongst patients having surgery. Hospitals not using a surgical safety checklist are endangering patient safety. If I were to need an operation, I would want to be treated somewhere using a surgical checklist.” (NPSA 2010).
Tom is then shown to the changing room area where he is given a gown to change into. Confidentiality is once more most important at this stage as the operating department practitioner is in possession of Tom’s hospital records and they could both also be surrounded by other patients’, so talking discreetly and not misplacing the records is a must. Confidentiality is a major part of the health care system (NMC 2008). When talking to patients in an open area, discretion must be maintained at all times. Any personal data belonging to a patient such as their medical records must never be left unattended or in the view of other patients. At the beginning of the day, the list of patients and procedures are written onto the white board in the theatre, but if the list consists of patients coming in for intra-muscular injections, there would be a chance of a patient seeing another patients name and details, therefore other names are covered over so to only show the patients details that are currently in the theatre. At the end of the day the theatre list for that day is put in a box which is then sent for confidential waste removal. (Hind and Wicker ????)
As outlined in the Department of Health’s Confidentiality Code of Practice requirements must be met to provide patients with a confidential service.
Protect – Look after the patient’s information
Inform – Ensure that patients are aware of how their information is used
Provide choice – Allow patients to decide whether their information can be -disclosed or used in particular ways
Improve – Always look for better ways to protect, inform and provide choice
Patients should be informed of how their information is kept and they should also be asked if they are happy for their personal medical information to be used for other than that of the procedure that is being done. As an example, there maybe medical research or trials being done on the prostate, and patients information could help with the research but without the patients consent this information would not be allowed to be passed on to a third party. (Department of Health 2003)
Confidentiality is a continuous requirement throughout all areas and any organisation must be bound by the Data Protection Act (1998) which is a regulation of how personal data of people is used and to avoid misuse of information.
Once Tom is changed the operating department practitioner takes Tom to the anaesthetic room where he is asked to sit upon a trolley bed whilst further checks are made such as, the last time Tom had anything to eat or drink, where the operation site was and had it been marked correctly according to paperwork. Also to ensure the consent form had been completed, whether Tom had any metal work within his body (this is asked as diathermy maybe used for the procedure), and to also ask Tom if he knew and understood the procedure he was about to have. Any personal belongings that Tom has bought into the anaesthetic room are placed in a transparent plastic bag, this bag is closed with a tie knot and a label identifying Tom’s details such as his hospital number and date of birth is attached on the outside of the bag. Tom’s personal belongings are documented (Kumar ????). Whilst all these are checked the operating department practitioner has to be very mindful that all this information that has been collated is once again very confidential and must be kept securely and accurately during the procedure, as keeping the patients records is a requirement of practice of all health care professionals. (NMC 2011).
Professional codes of conduct relates here also as The Health Professional Council (HPC) Standards of Conduct, Performance and Ethics (HPC 2008) states “you must keep your professional knowledge and skills up to date. You must make sure that your knowledge, skills and performance are of a high quality, up to date and relevant to your field of practice”. The College of Operating Department Practitioners (CODP) is the professional body for operating department practitioners who provide support to registered and unregistered practitioners. (CODP 2011)
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As the operating department practitioner becomes the patients’ advocate it is important to take care with any conversations that take place whilst the patient is in their care, talking about food when the patient has been nil by mouth for a period of time would be deemed very insensitive and not professional nor is an anaesthetist walking in the anaesthetic room eating a sandwich which has been known to happen.
Patient advocacy is speaking for someone else when they are unable to do so themselves whether it be because the patient is too weak or they are anaesthetised. It is an important part of an operating department practitioner’s job being the patient’s ears and voice throughout their theatre journey. Boyle (2005) states that patients depend on nurses to help them through the changing healthcare system. This is also true of practitioners working with patients in the perioperative area. Advocacy is a critical issue for surgical patients who are unconscious or sedated and unable to make decisions related to their care. (Wicker and O’Neill 2010)
The checks that have been made and the monitoring equipment that has been attached to Tom are routine with every procedure to check the patients health prior to anaesthetic. Evidence based practice would come into action here once again proving that constantly monitoring patients with such equipment is a high priority to ensure they are in good health prior to anaesthetic right through to when they leave the theatre department.
The operating department practitioner now prepares Tom to be anaesthetised. For the procedure that Tom was undergoing he could have a spinal block anaesthetic but Tom’s choice was to have a general anaesthetic and as a result was unconscious from this point onwards. This is where patient advocacy comes into play as once the patient is anaesthetized they are unable to speak for themselves and we as operating department practitioners have to speak for them and ensure they are safe at all times. At times in the anaesthetic room a number of people can be in the room, but it is for the operating department practitioner to ask any unnecessary personnel needed in the room to leave (this would also happen if the patient was awake, as it would be very daunting for the patient to be surrounded by so many people, it would make the patient more anxious than they already were. (Hind and Wicker ????)
Now it is time to transfer Tom to the operating room, the team, including surgeons, scrub practitioners and circulating staff await. Tom will be in lithotomy position for his procedure and once transferred across to the operating table monitoring equipment is reattached to once again continue checking on Tom’s health. A diathermy plate is positioned on Tom’s abdomen ensuring the skin was dry and clean before attaching. Diathermy is used to cauterize and coagulate once an incision has been made using an electrical current, therefore it is imperative that the plate is placed correctly on Tom to avoid any burns. Once Tom is draped and the anaesthetist has given the go ahead for the procedure to start the WHO checklist is done. The WHO checklist or safer surgery checklist it is also called has a series of questions that would include once again confirm the patients identity, the procedure that is about to take place, ask the anaesthetist if they have any concerns about the patients health. Evidence Based Practice shows that having the WHO checklist can and does save lives. “The use of checklists significantly reduces surgical morbidity and mortality”. (WHO 2011).
During the operation records are kept such as the anaesthetist recording at regular intervals temperature, heart rate, blood pressure and CO2 levels. The circulating staff record on the hospital trust computer system what members of staff are present in the theatre during the procedure and check the procedure is correctly documented on the system and in the patient’s manual records. The circulating staff also complete a patient care plan form, which would document things like whether the patient has flowtron boots on his legs, whether a diathermy plate is being used and where it has been positioned. Patient advocacy would be active here also as the operating department practitioner would be the eyes, ears and voice for the patient during this time, and if the operating department practitioner feels something that is either being done or not being done to the patient that he did not agree with then it is for the operating department practitioner to shout up his views.
Once the operation is complete anaesthetic gases are stopped and Tom is closely monitored by the operating department practitioner and anaesthetist who are waiting for Tom to start breathing for himself ready for transfer to the recovery ward. Whilst Tom is coming out of anaesthesia good verbal skills are required by both the operating department practitioner and anaesthetist towards Tom to ensure he awakes as calm and relaxed as can be, to reassure him and inform Tom that the procedure is complete.
When Tom is ready to be transferred to the recovery ward, the operating department practitioner accompanies him and also takes his medical records which would also include the anaesthetic record sheet and theatre care plan sheet. On arrival at the recovery ward the operating department practitioner introduces the recovery nurse to Tom as she will now be caring for Tom. The operating department practitioner goes through the theatre care plan and gives the recovery nurse information such as the procedure that has just taken place, whether any local anaesthetic was given, what dressings have been used. Discussing this information must be done in a discreet manner as there will be other patients on the recovery ward and there could be a risk of Tom’s personal information being overheard by other patients. Although there are curtains that can surround Tom’s bed these can only protect him physically unfortunately they are not sound proof. Again confidentiality and patient advocacy must be carried out here also.
Throughout the journey within the theatre department professional conduct is a requirement of all staff. The HPC states “as a health professional, you must protect the health and wellbeing of people who use or need your services in every circumstance and that the standards of conduct, performance and ethics apply to every registrant and prospective registrant”. (HPC 2011). And as stated by Dimond (2004) “Lack of experience, ability or competence is not acceptable as a form of defence, and neither is team liability. Qualified practitioners are accountable not only for their own interventions but also for those of support staff and students. Therefore, they should refer to their standards for practice, which clearly illustrate their roles and responsibilities.
Dignity and care of patients should be of high standards at all times and staff should consider a patients holistic, physical, social, spiritual and emotional needs. (RCN 2011). As stated by the Care Quality Commission (CQC) ” We promote improvements in the quality of care above and beyond essential quality standards. We do this by working with people who arrange local health and adult social care services – for example local councils and primary care trusts (commissioners) and those who provide them – for example hospitals.
In conclusion I have discussed professionalism, codes of conduct, patient advocacy and confidentiality in relation to Tom, a 65 year old man who came into theatre for TURP. I have shown where each topic relates to Tom’s journey within the theatre department and explained why these are important factors within the care of the patient.
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